Fatores nutricionais e hipertensão arterial na cidade de Ouro Preto Minas Gerais

Abstract

In the last years, an increased prevalence of arterial hypertension (AH) has been observed. It is known that the risk of developing AH is associated to exposure to factors called non modifiable, such as personal and demographic characteristics (heredity, age, sex, race/ethnic), as well as to modifiable ones, such as clinical, nutritional and behavioral factors. Both of them can act isolated or combined with socio-economic conditions, according to characteristics of thepopulation group studied. The present investigation is a cross-sectional study with application of home inquiry and assessment of clinical and laboratorial data in the School of Pharmacy, Federal University of Ouro Preto, and had as objective to investigate indicators related to the occurrence of AH in the population resident in the town of Ouro Preto. In the first phase of the investigation, the subjects older than 15-year old, selected by random simple process, were studied in order to verify the prevalence of overweight and obesity, using as indicator the Body Mass Index (BMI) and Waist Circumference (WC) according to social, demographic and inactivity physical characteristics. By combination between BMI and WC, the population in nutritional risk was defined. The following next phase, due to multi-race characteristics of the population, the proposal was to determine the sensitivity, specificity and discriminatory power of anthropometric measures obtained through different methods, in the determination of obesity among 20 to 79-year old individuals. The last phase it was investigated the prevalence of arterial hypertension and associated factors, in the population of 20 to 79 years, using cut-off points to BMI, WC and % body fat (%BF). It was observed that the nutritional risk classified by WC was present in different categories of BMI both amongst women and in men, being respectively 19% and 1.4% among those with normal weight, 91.7% and 56% among those with overweight and 98.5% and 80% among those with obesity. Age and educational level were associated independently of nutritional risk. Women and men above 60 years presented an odds ratio (OR) of combined nutritional risk of 9.95 and 14.35-fold higher than younger ones. Women with educational level £ 4 years, showed an OR of 1.74when compared with those with more than 4 years, and in men of medium educational level was 2.55 in relation to those that presented high educational level Among women <40, cut-off points were: BMI 26 Kg/m2, WC 84 cm and %BF 34%; in those . FXW-off points were 28 Kg/m2 90cm and 37.4%, respectively. Among men <40 years, the cut-off points were BMI 26.3 Kg/m2, CC 86cm and %BF 22.5%, and in those 89 cm and 24.5%, respectively. In relation to results of 2nd phase, the BMI was the method with higher area under the curve (AUC) independently of sex and sex/age, not being observed difference in the AUC of BMI and WC. The stratification by skin colour did not modify the discriminatory power of any indicator. In the last phase, it was found a prevalence of arterial hypertension of 43.8%, which varied with some population characteristics. Among women, the factors that showed independent association with AH were age of 40 to 59 years (6.5 CI 95%: 3.6; 11.7), ³60 years (31.6 CI 95%: 10.0; 100.3), classes D and E (3.6 CI 95%: 1.4; 9.7), CC (2.7 CI 95%: 1.6; 4.8) and blood glucose (2.0 CI 95%: 1.1; 3.7). Among men those factors were age 40 to 59 years (2.5 CI 95%: 1.4; 4.6), ³60 years (11.1 CI 95%: 3.9; 31.4), non-white skin colour (2.4 CI95%: 1.1; 4.9), % BF (2.7 CI 95%: 1.6; 4.8), glucose (2.0 CI 95%: 1.1; 3.6) and cholesterol (3,9 CI 95%: 2.0; 7.5). From the calculated population attributable risk, the importance of modifiable factor risks was detected. It was observed a decrease of WC and blood glucose values in women, which can reduce in respectively 41% to 29% the occurrence of AH. Amongst men a decrease of total cholesterol, obesity by %BF and glucose of respectively 57%, 44% e 32 was observed. The results of this study showed the importance of using several risk indicators according to sex for the selection of risk groups for AH, and also showed the urgency of implementation of primary actions that act in reducing the exposure to modifiable risk factors, which can minimize the effect of age in reducing the premature death risk by cardiovascular diseases.